CPNRE Maternal and Newborn Care 2 — Questions and Answers
Question 1: A woman at 32 weeks gestation reports painless, bright red vaginal bleeding. Which condition does this presentation most suggest?
- Placental abruption
- Placenta previa (Correct answer)
- Normal bloody show
- Cervical polyp
Correct answer: Placenta previa
Painless bright red vaginal bleeding in the third trimester is the classic presentation of placenta previa.
Placenta previa: painless, bright red vaginal bleeding (often after 28 weeks) due to the low-lying placenta covering the cervical os. Placental abruption: painful dark red bleeding, uterine rigidity, and fetal distress. Priority actions for placenta previa: do NOT perform vaginal examination (can precipitate massive hemorrhage); maintain bed rest; IV access and fluid replacement; fetal monitoring; notify physician immediately; prepare for possible emergency cesarean section. Managed per SOGC (Society of Obstetricians and Gynaecologists of Canada) guidelines.
Question 2: A newborn receives a 1-minute Apgar score of 5. Which interpretation and action is correct?
- Score of 5 is normal, no action needed
- Score of 5 indicates moderate depression requiring full CPR
- Score of 5 indicates mild to moderate depression requiring stimulation and supplemental oxygen (Correct answer)
- Score of 5 is critical requiring immediate intubation
Correct answer: Score of 5 indicates mild to moderate depression requiring stimulation and supplemental oxygen
Apgar 4-6 indicates mild to moderate depression requiring stimulation (drying, rubbing back) and supplemental oxygen.
Apgar scoring (Heart rate, Respiratory effort, Muscle tone, Reflex irritability, Color, each 0-2 points): 7-10 = routine care; 4-6 = mild to moderate depression: dry, stimulate (rub back, flick soles), reposition airway, supplemental oxygen by mask; 0-3 = severe: requires positive pressure ventilation, possibly cardiac compressions and medications. A 5-minute Apgar of 7+ after intervention is reassuring. Canadian NRP (Neonatal Resuscitation Program) protocols are endorsed by the Canadian Paediatric Society.
Question 3: A nursing mother reports breast engorgement on postpartum day 2. Which advice should the practical nurse provide?
- Stop breastfeeding to allow engorgement to resolve
- Apply ice packs continuously and limit feeding frequency
- Feed frequently on demand, ensure proper latch, and apply warm compress before feedings (Correct answer)
- Supplement with formula between feedings to reduce demand
Correct answer: Feed frequently on demand, ensure proper latch, and apply warm compress before feedings
Frequent, effective breastfeeding with proper latch resolves engorgement; warm compresses before feeding stimulate let-down.
Breast engorgement typically peaks on postpartum days 2-4. Management: feed frequently on demand (8-12 times per 24 hours); ensure correct latch; apply warm compress before feedings to stimulate let-down; cold packs between feedings for comfort; gentle massage; ensure complete drainage; avoid formula supplementation which worsens engorgement. Aligns with Canadian public health breastfeeding guidelines, Health Canada Nutrition for Healthy Term Infants recommendations.
Question 4: During oxytocin infusion, the fetal heart rate drops from 140 to 80 bpm coinciding with each contraction and returning to baseline quickly. How should this be interpreted?
- Early decelerations indicating head compression, normal finding (Correct answer)
- Late decelerations indicating uteroplacental insufficiency
- Variable decelerations indicating cord compression
- Accelerations indicating fetal well-being
Correct answer: Early decelerations indicating head compression, normal finding
Decelerations that begin with contraction onset and return to baseline quickly (mirror contractions) are early decelerations from head compression, a benign finding.
Fetal heart rate deceleration classification: Early decelerations: uniform shape, begin with contraction onset, nadir at contraction peak, return to baseline by contraction end; vagal response to fetal head compression during descent; NORMAL. Late decelerations: begin after contraction onset, nadir after peak, return after contraction; uteroplacental insufficiency; NON-REASSURING. Variable decelerations: abrupt onset/offset, vary in timing; cord compression. SOGC fetal surveillance guidelines define these patterns. Correct identification prevents unnecessary interventions for normal patterns.
Question 5: A client who delivered vaginally 6 hours ago has a fundal height at the umbilicus, deviated to the right, and a boggy uterus. What should the practical nurse suspect?
- Normal postpartum uterine involution
- Bladder distension causing uterine displacement and atony (Correct answer)
- Retained placental fragment
- Postpartum hemorrhage from uterine atony
Correct answer: Bladder distension causing uterine displacement and atony
A boggy uterus deviated to the right 6 hours postpartum typically indicates bladder distension preventing effective uterine contraction.
At 1 hour postpartum, the fundus should be firm, midline, at or below the umbilicus. A uterus deviated to the right that is boggy suggests a full bladder (most common cause). Actions: have client void; assist to bathroom or catheterize if unable; assess urine output; after voiding, palpate uterus for firmness. If uterus remains boggy: fundal massage; oxytocin as ordered; notify physician. Uterine atony is the leading cause of postpartum hemorrhage. Differentiating bladder distension from true uterine atony is a core competency in Canadian postpartum nursing.
Question 6: A term newborn has not voided in the first 24 hours after birth. What is the priority nursing action?
- Normal since newborns may not void for 48 hours
- Assess for bladder distension, ensure adequate feeding, and notify the physician (Correct answer)
- Administer IV fluids to encourage renal perfusion
- Insert a urinary catheter to measure output
Correct answer: Assess for bladder distension, ensure adequate feeding, and notify the physician
Failure to void within 24 hours is abnormal and requires assessment for bladder distension, feeding adequacy, and physician notification to rule out urinary obstruction.
Normal first void should occur within 24 hours of birth. No void requires: assess suprapubic area for bladder distension; assess feeding frequency and intake adequacy; assess for dehydration signs; notify physician. No void at 24 hours requires medical evaluation to rule out posterior urethral valves, ureteropelvic junction obstruction, or other urinary tract anomalies. In males, inspect for hypospadias or epispadias. This is a critical newborn nursing assessment parameter per Canadian Paediatric Society (CPS) newborn care guidelines.
CPNRE Maternal and Newborn Care 2
A woman at 32 weeks gestation reports painless, bright red vaginal bleeding.
Which condition does this presentation most suggest?